RESEARCH QUESTIONNAIRE: OVER-THE-COUNTER MEDICATIONS
_____________________________________________________________________
Dear Ms/Mr
The questionnaire you have received applies only to the use of over-the-counter
medications, which you may buy in your pharmacy. Physicians are often
insufficiently informed about the use of these medications. The purpose of our
research is thus to improve the quality of information obtained from your
pharmacist.
The questionnaire is anonymous and doesn’t contain any personal information.
Please fill it out and return it in an envelope at your next visit of the pharmacy. Please
mark the correct answers with a cross „“.
We thank you for your time and willingness to supply us with valuable information.
The questionnaire was developed as a part of the research of the Faculty of Medicine,
Comenius University in cooperation with the Faculty of Pharmacy, Comenius
University in Bratislava.
Before you mark the answer with a cross, please read all the options and choose
the most suitable one. The number of options you can choose is stated next to
each question.
1.
How do you rate your health status? (choose 1 answer)
 very good
 good  neither good nor bad  bad
 very bad
2.
How do you rate your health status compared to peers? (choose 1 answer)
 better
 approximately equal
 worse
3.
Do your health problems cause you any problems in the everyday life? (choose 1
answer)
 yes
 no
 mostly no
 mostly yes
4.
What long-term chronic diseases do you suffer from? (you may choose multiple
answers)
 I do not suffer from any long-term chronic diseases
 high blood pressure
 cancer
 skin disease
 diabetes
 depression
 allergy
 heart disease
 glaucoma
 asthma
 high cholesterol/ lipids
 thyroid gland disease
 chronic
 stomach disease
 inflammatory disease
obstructive
 intestinal disease
of the joints and/or
pulmonary
spine
disease
 liver disease
 anaemia
 osteoporosis
 urinary tract disease
 prostate disease
 other (please specify) .......................................................................................
5.
How often do you visit your general practitioner? (choose 1 answer)
 once a year for a preventive examination  once a month
 once every 6 months
 more often than once a month
 once every 3 months
 I do not visit a general practitioner
6.
Do you have problems with sleeping? (choose 1 answer)
 never
 often (at least twice a week)
 rarely (once a week at most)
 very often (5 – 7 times a week)
7.
Do you have feelings of anxiety, fear, hopelessness and sadness? (choose 1
answer)
 never
 often (at least twice a week)
 rarely (once a week at most)
 very often (5 – 7 times a week)
8.
How often do you take over-the counter medications? (choose 1 answer)
 every day
 less often than every day
9.
If every day, how many times a day do you use an over-the counter medication?
(choose 1 answer)
 when necessary, when I have problems  three times a day
 once a day
 more than three times a day
 twice a day
10.
How long have you been taking an over-the-counter medication? (choose 1
answer)
 6 months or more
 less than 6 months
11.
Do you consult your physician or pharmacist on using over-the-counter
medications? (choose 1 answer)
 no, never
 often, but not always
 only the first time I buy such a medication  yes, always
12.
Which symptoms were the reasons for you buying over-the-counter medication?
(you may choose multiple answers)
 fever
 pain
 digestive problems
 cough
 allergic symptoms
 other (please specify) .........................................................................
13.
How long had your problems persisted before you bought an over-the counter
medication? (choose 1 answer)
 I bought it at the
 longer than 1 month and less
beginning of my problems
than 6 months
 less than 7 days
 6 months and longer
 7 – 30 days
2
14.
Do you consider over-the-counter medications effective? (choose 1 answer)
 yes
 mostly yes  mostly no  no
 I don’t know
15.
What did you do when the over-the-counter medications were not effective
enough? (choose 1 answer)
 I used other over-the-counter medications without consulting a physician or
pharmacist
 I sought out medical help
 I consulted a pharmacist
 I was never in this situation
 other (please specify).................................................
16.
Do you consider over-the-counter medications to be safe? (choose 1 answer)
 yes
 mostly yes  mostly no  no
 I don’t know
If you answered „ no“ or „mostly no“ or „I don’t know“, move on to question 18.
17.
What reasons led you to consider over-the-counter medications safe or mostly
safe in question 16? (you may choose multiple answers)
 using over-the-counter medications doesn’t require consulting a physician
 their long-term usage doesn’t lead to adverse side effects
 after taking these medications I have never felt any adverse side effects
 other (please specify)..............................................................
18.
If you have ever had adverse side-effects when taking an over-the-counter
medication, please specify which side-effects.
.................................................................................................................................
19.
If you have ever had adverse side effects when taking an over-the-counter
medication, please specify the name of the medication which caused them.
.................................................................................................................................
20.
Who would you inform of any adverse side effects if they occurred? (you may
choose multiple answers):
 a physician
 State Institute for Drug Control  relatives/
acquaintances
 a pharmacist  nobody
21.
What factors do you think may increase the risk of adverse side effects of overthe-counter medications? (you may choose multiple answers)
 higher age
 simultaneous presence of multiple
diseases
 long-term usage of over-the-  concurrent use of several medications
counter medication
 taking higher doses than recommended in the patient information leaflet
 other (please specify).................................................
3
22.
Do you think that over-the-counter medications can interact with medications
prescribed by your physician? (choose 1 answer)
 yes
 mostly yes  mostly no  no
 I don’t know
23.
What is the source of information on over-the-counter medications for you? (you
may choose multiple answers)
 pharmacist
 physician
 leaflet
 internet
 relatives /
 books / journals
 television
 radio
acquaintances
 other (please specify).....................................................
24.
Do you consider the patient information leaflet to received with your over-thecounter medications to be an adequate source of information about the
medication? (choose 1 answer)
 yes
 mostly yes  mostly no  no
 I don’t know
25.
Do you read the patient information leaflet when using over-the-counter
medications? (you may choose multiple answers)
 I do not read the leaflet
 only if it’s my first time using this medication
 if I suspect an adverse side-effect
 if I want to know how to take the medication (e.g. the dosage)
 always when buying such a medication
If you answered that you do not read the leaflet, move on to question 30.
26.
If you read the leaflet, which information do you consider very important? (you
may choose multiple answers)
 which diseases is it used for
 possible adverse side-effects
 when is it forbidden to use the
 how to store the medication
medication
 with which medications it shouldn’t  the list of adjuvants
be combined
 how to use the medication (dosage)
27.
What are the most important problems with the leaflets? (you may choose
multiple answers)
 unclear information in the leaflet
 too many adverse side-effects listed
 small letters
 obscure terms, too many foreign words
 I do not see any shortcomings
 other (please specify)....................................................................................
28.
Does listing of too many adverse side-effects in the leaflet lead you to worry
about using a medication? (choose 1 answer)
 yes
 mostly yes
 mostly no
 no
4
29.
How well do you follow the dosage recommended in the leaflet when using
over-the-counter medications? (you may choose multiple answers)
 yes, I follow the recommended dosage
 I take higher doses than recommended
 I take lower doses than recommended
 I take doses as necessary (sometimes higher, sometimes lower than the
recommended doses)
30.
What reasons led you to prefer buying over-the-counter medications to visiting a
physician? (you may choose multiple answers)
 I am discouraged by long waiting at the physician’s office
 I don’t want to bother the physician each time
 quick purchase of over-the-counter medications in pharmacy
 the wide range of over-the-counter medications in pharmacy
 other (please specify)....................................................
31.
When choosing an over-the-counter medication, what factors influenced your
choice (you may choose multiple answers)
 experience with the
 the company that manufactures the
 price
medication
 recommendation of a
medication (its reputation)
 advices of relatives / acquaintances
 advertisement
physician
 recommendation of a
 other (please specify)............................................
pharmacist
32.
Do you think that over-the-counter medications could be purchased outside the
pharmacy, without the supervision of a pharmacist? (choose 1 answer)
 yes
 mostly yes  mostly no  no
 I don’t know
33.
The over-the-counter medication you bought last time: (choose 1 answer)
 was bought for the first time
 you buy it repeatedly
34.
How much money do you spend on over-the-counter medications per month?
(choose 1 answer)
 up to 5 Euros
 11-20 Euros
 6-10 Euros
 more than 20 Euros
35.
How much money do you spend on supplementary payments for prescription
only medications per month? (choose 1 answer)
 up to 5 Euros
 11-20 Euros
 6-10 Euros
 more than 20 Euros
 I do not pay anything for prescription only medications
36.
Where do you buy your over-the-counter medications? (choose 1 answer)
 always in the same pharmacy
 in different pharmacies
5
37.
How often do you use herbal medicinal products? (choose 1 answer)
 less than once a month
 every day
 at least once a month
 I do not use them
 at least once a week
38.
Do you think that using herbal medicinal products can lead to adverse side
effects? (choose 1 answer)
 yes
 mostly yes  mostly no  no
 I don’t know
39.
Do you think that herbal medicinal products can interact with other medications?
(choose 1 answer)
 yes
 mostly yes  mostly no  no
 I don’t know
40.
List all the over-the-counter medications you are using at present time:
................................................................................................................................
................................................................................................................................
................................................................................................................................
41.
List all the prescription only medications you are using at present time:
................................................................................................................................
................................................................................................................................
................................................................................................................................
................................................................................................................................
................................................................................................................................
42.
List the herbal medicinal products or herbal teas you are using at present time:
...........................................................................................................................................
...........................................................................................................................................
43.
44.
Do you smoke? (choose 1 answer)
 I am a non-smoker
 I smoked in the past
 I smoke irregularly, not every day
 I smoke less than 10 cigarettes a day
 I smoke 11 to 30 cigarettes a day
 I smoke over 30 cigarettes a day
Do you drink alcohol? (choose 1 answer)
 I do not drink at all
 I drink occasionally
 I drink 1-2 beers or 1-2 glasses of wine or 1-2 glasses of spirits a day
 I drink 3 or more beers or 3 or more glasses of wine or 3 or more glasses of
spirits a day
6
45.
Gender:
 male
 female
46.
Age: ...................... (years old)
47.
Your mother tongue is:
 Slovak
 Hungarian
 other (please specify).............................
48.
What is your marital status?
 married
 widowed
 single
 divorced
49.
What is your highest completed level of education?
 elementary school
 high school with graduation
 high school without graduation
 university
50.
Professional background:
 health care professionals
51.
52.
53.
54.
 others
Do you live:
 alone
 with another person or other
people
 in a retirement home
Who looks after you? (choose 1 answer)
 I look after myself
 son/daughter
 grandson/granddaughter
 husband/wife
 neighbours
 acquaintances
 partner
 retirement home personnel
Currently, you are:
 retired
 employed
 an employed retiree
Do you live:
 in a city
 in a village
Thank you for your time and cooperation.
7